Aparicio Javier, Niñerola-Baizán Aida, Perissinotti Andrés, Rubí Sebastià, Muchart Jordi, Candela-Cantó Santiago, Campistol Jaume, Setoain Xavier
Neurology Department, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, Esplugues de Llobregat, Barcelona 08950, Spain; Epilepsy Unit, Member of ERN-EpiCARE, Sant Joan de Déu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, Esplugues de Llobregat, Barcelona 08950, Spain.
Nuclear Medicine Department, Hospital Clínic, C/Villarroel 170, Barcelona 08036, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.
Seizure. 2022 Apr;97:43-49. doi: 10.1016/j.seizure.2022.03.010. Epub 2022 Mar 15.
Children with drug-resistant focal epilepsy have a compromised quality of life. Epilepsy surgery can control or significantly reduce the seizures. We assessed and compared the usefulness of PISCOM, a new nuclear imaging processing technique, with SISCOM and 18F-FDG PET (FDG-PET) in pre-surgical evaluation of paediatric drug-resistant focal epilepsy.
Twenty-two children with pharmcorefractory epilepsy, mainly extratemporal, who had undergone pre-surgical assessment including SISCOM and FDG-PET and with postsurgical favorable outcome (Engel class I or II) for at least two years, were included in this proof-of-concept study. All abnormalities observed in SISCOM, FDG-PET and PISCOM were compared with each other and with the known epileptogenic zone (EZ) based on surgical treatment, histopathologic and surgical outcome results. Global interobserver agreement, Cohen's Kappa coeficient and PABAK statistic were calculated for each technique.
PISCOM concordance with the known EZ was significantly higher than SISCOM (p<0.05), and no statistically differences were found with FDG-PET. PISCOM showed successful identification in 19 of 22 cases (86%), successful concordant with FDG-PET in 17 (77%), and SISCOM in 11 (50%). If we consider PISCOM and FDG-PET results together, both techniques successfully localized the known EZ in all cases. The measures of agreement between two experts in nuclear medicine were higher in PISCOM than in SISCOM and FDG-PET.
PISCOM could provide complementary presurgical information in drug-resistant paediatric focal epilepsy, particularly in cases in which FDG-PET is doubtful or negative, replacing SISCOM and sparing the use of interictal SPECT.
耐药性局灶性癫痫患儿的生活质量受到影响。癫痫手术可以控制或显著减少癫痫发作。我们评估并比较了一种新的核成像处理技术PISCOM与SISCOM和18F-FDG PET（FDG-PET）在小儿耐药性局灶性癫痫术前评估中的效用。
本概念验证研究纳入了22例主要为颞叶外的药物难治性癫痫患儿，这些患儿均接受了包括SISCOM和FDG-PET在内的术前评估，且术后至少两年预后良好（Engel分级为I级或II级）。将SISCOM、FDG-PET和PISCOM中观察到的所有异常相互比较，并与基于手术治疗、组织病理学和手术结果的已知致痫区（EZ）进行比较。计算每种技术的观察者间总体一致性、Cohen's Kappa系数和PABAK统计量。
PISCOM与已知EZ的一致性显著高于SISCOM（p<0.05），与FDG-PET相比无统计学差异。PISCOM在22例中的19例（86%）成功识别，与FDG-PET成功一致的有17例（77%）,与SISCOM成功一致的有11例（50%）。如果将PISCOM和FDG-PET结果综合考虑，两种技术在所有病例中均成功定位了已知EZ。核医学领域两位专家之间的一致性测量在PISCOM中高于SISCOM和FDG-PET。
PISCOM可为耐药性小儿局灶性癫痫提供补充性术前信息，尤其是在FDG-PET结果可疑或为阴性的情况下，可取代SISCOM并避免使用发作间期SPECT。
